Using force sensor to give angle of ultrasound beam

ABSTRACT

Catheterization is carried out by inserting a probe into a cavity in a body of a subject. The probe has a contact force, a transmitter, a receiver, and an ultrasound transducer in its distal segment. After navigating the probe into contact with a target in a wall of the cavity using the contact force sensor, a desired contact force is established and maintained between the probe and the target. Responsively to readings by the receiver of signals from the transmitter, the distal end of the probe is oriented orthogonally to the target.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. patent applicationSer. No. 14/974,731, filed Dec. 18, 2015, the entire contents of whichare hereby incorporated by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

This invention relates to devices and methods for transferring energy tothe body with a catheter. More particularly, this invention relates todevices and methods for operating a catheter by transferring mechanical,ultrasonic and electromagnetic energy to the body.

2. Description of the Related Art

Radiofrequency (RF) ablation is widely used for treating cardiacarrhythmias. RF ablation is commonly carried out by inserting a catheterthrough the patient's vascular system into the heart, and bringing thedistal tip of the catheter into contact with the cardiac tissue at thesite that is to be ablated. RF electrical current is then conductedthrough wires in the catheter to one or more electrodes at the tip ofthe catheter, which apply the RF energy to the myocardium. The RF energyis absorbed in the tissue, heating it to the point typically about50°-60° C.) at which it permanently loses its electrical excitability.When this sort of procedure is successful, it creates non-conductinglesions in the cardiac tissue, which disrupt the abnormal electricalpathway causing the arrhythmia.

It is often difficult to determine the proper dosage of RF energy thatshould be applied in an ablation procedure in order to achieve thedesired result. When the dosage is insufficient, the non-conductinglesion will not extend deeply enough through the heart wall to disruptthe abnormal conduction, so that arrhythmia may persist or return afterthe procedure is completed. On the other hand, excessive RF dosage maycause dangerous damage to the tissue at and around the ablation site.The proper RF dosage is known to vary from case to case depending onvarious factors, such as catheter geometry, thickness of the heart wall,quality of the electrical contact between the catheter electrode and theheart wall, and blood flow in the vicinity of the ablation site (whichcarries away heat generated by the RF energy).

In order to improve the precision and consistency of RF ablationprocedures, attempts have been made to predict and control the ablationbased on measurement of physiological parameters of relevance.

SUMMARY OF THE INVENTION

According to disclosed embodiments of the invention, a flexible cardiaccatheter has an ablation electrode, a distal force sensor,radio-frequency transmitter and a radio-frequency receiver located atthe distal end and the proximal end of a contact force sensor comprisinga spring and an ultrasonic transducer into the distal tip of thecatheter, on the axis of the tip. If there is no force on the tip, or ifthe force is parallel to the distal end axis, then the distal andproximal ends of the spring align, and the distal tip axis aligns withthe axis of the distal portion of the catheter. If there is anasymmetrical force on the tip, then the two axes do not align. In allcases the orientation of the transducer, the beam emitted by thetransducer may be calculated, and the alignment or nonalignment of thetwo axes may be determined. Once the axes are aligned, the ultrasoundtransducer may be operated in A-mode and the tension on the contactforce sensor read in order to establish tissue structure and contactforce for determination of ablation power and duration.

There is provided according to embodiments of the invention a method,which is carried out by inserting a probe into a cavity in a body of asubject, the probe has a contact force sensor, a transmitter, a receiverand an ultrasound transducer in the distal segment, The method isfurther carried out by navigating the probe into contact with a targetin a wall of the cavity, and according to readings of the contact forcesensor establishing a desired contact force between the probe and thetarget. Responsively to readings by the receiver of signals from thetransmitter, the ultrasound transducer is positioned orthogonally to thetarget.

According to an aspect of the method, the contact force sensor isdisposed between the transmitter and the receiver.

In one aspect of the method after orienting the ultrasound transducerthe ultrasound transducer is activated to emit ultrasound signals, andecho signals returning from the emitted ultrasound signals are processedto determine a structure of the target.

According to still another aspect of the method, determining a structureof the target includes determining a thickness of the wall of thecavity.

Another aspect of the method is carried out responsively to thedetermined structure of the target by calculating ablation parameters,and activating an ablation electrode according to the ablationparameters to ablate the target.

According to a further aspect of the method, the distal segment has anaxis of symmetry, the ultrasound transducer is centered on the axis ofsymmetry, and ultrasound signals emitted by the ultrasound transducerpropagate along the axis of symmetry.

According to another aspect of the method the ultrasound transducer isoffset from the axis of symmetry, and ultrasound signals emitted by theultrasound transducer propagate parallel to the axis of symmetry.

According to an additional aspect of the method, the transmitter is asingle frequency radiofrequency transmitter and the receiver has asingle receiving coil.

According to another aspect of the method, the contact force sensorforms a joint between a proximal portion of the probe and the tip of thedistal segment.

According to another aspect of the method, orienting the ultrasoundtransducer also includes aligning an axis of symmetry of the proximalportion with an axis of symmetry of the distal segment.

According to a further aspect of the method, orienting the ultrasoundtransducer is performed while maintaining the desired contact force.

There is further provided according to embodiments of the invention aflexible probe adapted for insertion into a body cavity of a patient.Within the probe are a transmitter and a position sensor for receivingsignals from the transmitter to sense a position of the distal tiprelative to the distal end of the probe, The probe has a resilientcontact force sensor disposed between the transmitter and the positionsensor, which couples the distal tip to the distal portion of the probeand is configured to deform in response to pressure exerted on thedistal tip when the distal tip engages a wall of the body cavity. Anultrasound transducer is disposed in the distal portion for directingultrasonic energy toward the wall, and a processor is linked to theposition sensor for determining an angular deviation between the distalportion and the proximal portion of the probe.

According to still another aspect of the apparatus, the processor isoperative to report that the distal tip is in alignment with the distalend of the probe.

According to another aspect of the apparatus, the processor isconfigured for activating the ultrasound transducer to emit ultrasoundsignals when the distal tip is in alignment with the distal end of theprobe, and for processing echo signals returning from the emittedultrasound signals to determine a thickness of the wall.

According to an additional aspect of the apparatus, an ablationelectrode is disposed on the distal tip, and the processor is configuredfor calculating ablation parameters responsively to the thickness of thewall, and activating the ablation electrode according to the ablationparameters to ablate tissue in the wall.

According to still another aspect of the apparatus, the distal end hasan axis of symmetry, and the ultrasound transducer is centered on theaxis of symmetry, and ultrasound signals emitted by the ultrasoundtransducer propagate along the axis of symmetry.

According to yet another aspect of the apparatus the ultrasoundtransducer is offset from the axis of symmetry, and ultrasound signalsemitted by the ultrasound transducer propagate parallel to the axis ofsymmetry.

According to a further aspect of the apparatus, the transmitter is asingle frequency radiofrequency transmitter and the position sensorincludes a single receiving coil.

According to one aspect of the apparatus, the contact force sensor formsa joint between the proximal portion of the probe and the distal end.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

For a better understanding of the present invention, reference is madeto the detailed description of the invention, by way of example, whichis to be read in conjunction with the following drawings, wherein likeelements are given like reference numerals, and wherein:

FIG. 1 is a pictorial illustration of a system for performing ablativeprocedures on a heart in accordance with an embodiment of the invention;

FIG. 2 is a partially cut away elevation of distal portion of a catheterin accordance with an embodiment of the invention;

FIG. 3 is a schematic, sectional view showing details of the distal endof the catheter, in accordance with an embodiment of the invention;

FIG. 4 is a graphical illustration of a receiver suitable for use in thecatheter shown in FIG. 3 in accordance with an embodiment of theinvention;

FIG. 5 is a graphical illustration of the distal portion of a catheterin an operating position in accordance with an embodiment of theinvention;

FIG. 6 is a graphical illustration of the distal portion of a catheterin an operating position in accordance with an embodiment of theinvention; and

FIG. 7 is a flow chart of a method of catheterization in accordance withan embodiment of the invention.

DETAILED DESCRIPTION OF THE INVENTION

In the following description, numerous specific details are set forth inorder to provide a thorough understanding of the various principles ofthe present invention. It will be apparent to one skilled in the art,however, that not all these details are necessarily needed forpracticing the present invention. In this instance, well-known circuits,control logic, and the details of computer program instructions forconventional algorithms and processes have not been shown in detail inorder not to obscure the general concepts unnecessarily.

Documents incorporated by reference herein are to be considered anintegral part of the application except that, to the extent that anyterms are defined in these incorporated documents in a manner thatconflicts with definitions made explicitly or implicitly in the presentspecification, only the definitions in the present specification shouldbe considered.

The terms “link”, “links”, “couple” and “couples” are intended to meaneither an indirect or direct connection. Thus, if a first device couplesto a second device, that connection may be through a direct connection,or through an indirect connection via other devices and connections.

Turning now to the drawings, reference is initially made to FIG. 1 ,which is a pictorial illustration of a system 10 for performing ablativeprocedures on a heart 12 of a living subject, which is constructed andoperative in accordance with a disclosed embodiment of the invention.The system comprises a catheter 14, which is percutaneously inserted byan operator 16 through the patient's vascular system into a chamber orvascular structure of the heart 12. The operator 16, who is typically aphysician, brings the catheter's distal tip 18 into contact with theheart wall, for example, at an ablation target site. Electricalactivation maps may be prepared, according to the methods disclosed inU.S. Pat. Nos. 6,226,542, and 6,301,496, and in commonly assigned U.S.Pat. No. 6,892,091, whose disclosures are herein incorporated byreference. One commercial product embodying elements of the system 10 isavailable as the CARTO® 3 System, available from Biosense Webster, Inc.,3333 Diamond Canyon Road, Diamond Bar, Calif. 91765. This system may bemodified by those skilled in the art to embody the principles of theinvention described herein.

Areas determined to be abnormal, for example by evaluation of theelectrical activation maps, can be ablated by application of thermalenergy, e.g., by passage of radiofrequency electrical current throughwires in the catheter to one or more electrodes at the distal tip 18,which apply the radiofrequency energy to the myocardium. The energy isabsorbed in the tissue, heating it to a point (typically about 50° C.)at which it permanently loses its electrical excitability. Whensuccessful, this procedure creates non-conducting lesions in the cardiactissue, which disrupt the abnormal electrical pathway causing thearrhythmia. The principles of the invention can be applied to differentheart chambers to diagnose and treat many different cardiac arrhythmias.

The catheter 14 typically comprises a handle 20, having suitablecontrols on the handle to enable the operator 16 to steer, position andorient the distal end of the catheter as desired for the ablation. Toaid the operator 16, the distal portion of the catheter 14 containsposition sensors (not shown) that provide signals to a processor 22,located in a console 24. The processor 22 may fulfill several processingfunctions as described below.

Ablation energy and electrical signals can be conveyed to and from theheart 12 through one or more ablation electrodes 32 located at or nearthe distal tip 18 via cable 34 to the console 24. Pacing signals andother control signals may be conveyed from the console 24 through thecable 34 and the electrodes 32 to the heart 12. Sensing electrodes 33,also connected to the console 24 are disposed between the ablationelectrodes 32 and have connections to the cable 34.

Wire connections 35 link the console 24 with body surface electrodes 30and other components of a positioning sub-system for measuring locationand orientation coordinates of the catheter 14. The processor 22, oranother processor (not shown) may be an element of the positioningsubsystem. The electrodes 32 and the body surface electrodes 30 may beused to measure tissue impedance at the ablation site as taught in U.S.Pat. No. 7,536,218, issued to Govari et al., which is hereinincorporated by reference. A temperature sensor (not shown), typically athermocouple or thermistor, may be mounted on or near each of theelectrodes 32.

The console 24 typically contains one or more ablation power generators25. The catheter 14 may be adapted to conduct ablative energy to theheart using any known ablation technique, e.g., radiofrequency energy,ultrasound energy, and laser-produced light energy. Such methods aredisclosed in commonly assigned U.S. Pat. Nos. 6,814,733, 6,997,924, and7,156,816, which are herein incorporated by reference.

In one embodiment, the positioning subsystem comprises a magneticposition tracking arrangement that determines the position andorientation of the catheter 14 by generating magnetic fields in apredefined working volume and sensing these fields at the catheter,using field generating coils 28. The positioning subsystem U.S. Pat. No.7,756,576, which is hereby incorporated by reference, and in theabove-noted U.S. Pat. No. 7,536,218.

As noted above, the catheter 14 is coupled to the console 24, whichenables the operator 16 to observe and regulate the functions of thecatheter 14. Console 24 includes a processor, preferably a computer withappropriate signal processing circuits. The processor is coupled todrive a monitor 29. The signal processing circuits typically receive,amplify, filter and digitize signals from the catheter 14, includingsignals generated by the above-noted sensors and a plurality of locationsensing electrodes (not shown) located distally in the catheter 14. Thedigitized signals are received and used by the console 24 and thepositioning system to compute the position and orientation of thecatheter 14 and to analyze the electrical signals from the electrodes.

During the procedure, contact force between the distal tip 18 orablation electrode 32 and the wall of the chamber may be measured asdescribed below.

Typically, the system 10 includes other elements, which are not shown inthe figures for the sake of simplicity. For example, the system 10 mayinclude an electrocardiogram (ECG) monitor, coupled to receive signalsfrom one or more body surface electrodes, so as to provide an ECGsynchronization signal to the console 24. As mentioned above, the system10 typically also includes a reference position sensor, either on anexternally-applied reference patch attached to the exterior of thesubject's body, or on an internally-placed catheter, which is insertedinto the heart 12 maintained in a fixed position relative to the heart12. Conventional pumps and lines for circulating liquids through thecatheter 14 for cooling the ablation site are provided. The system 10may receive image data from an external imaging modality, such as an MRIunit or the like and includes image processors that can be incorporatedin or invoked by the processor 22 for generating and displaying imagesthat are described below.

Reference is now made to FIG. 2 , which is a partially cut-away view ofdistal portion 41 of a catheter in accordance with an embodiment of theinvention. The distal portion 41 has an end portion 43 that comprises anablation electrode 45 mounted at tip 47. In this embodiment the ablationelectrode 45 has a distal annular portion 49 centered about an axis ofsymmetry 51 for making contact with tissue. Contact is optimal when theaxis of symmetry 51 is orthogonal to the tissue surface. A contact forcesensor 53 is located proximal to the ablation electrode 45 and proximalto an ultrasonic transducer 55. In this embodiment the ultrasonictransducer 55 is partially enclosed by the ablation electrode 45, andthe ultrasonic transducer 55 centered, so that its pulses transmit alongthe axis of symmetry 51. However, it is sufficient that there be a rigidalignment between the ablation electrode 45 and the ultrasonictransducer 55. For example, one or both of the ablation electrode 45 andthe ultrasonic transducer 55 could be offset from the axis of symmetry51, so long as the ultrasonic transducer 55 emits sound pulses parallelto the axis of symmetry 51. A temperature sensor 57 may be present inthe distal portion 41 to monitor temperatures at the ablation site.

A receiver 59 in the end portion 43 may be a set of three coils thathave a dual function. For a first function, the three coils act as alocation detector for the distal end, by generating position-dependentsignals from incident RF radiation produced by external field generatingcoils 28 (FIG. 1 ). The field generating coils 28 (typically also three)are fixed in a location pad that is positioned beneath a patient.Analysis of the position-dependent signal levels in the three receivingcoils gives the location and the orientation of the distal end.

As a second function, the three coils generate force-dependent signalsfrom the incident RF radiation produced by a transmitter 61. The twotypes of signals in the three coils—position-dependent and forcedependent—may be easily distinguished by using different frequencies forthe force transmitter and for the external RF radiators. Analysis of theforce-dependent signals gives the magnitude of the force on the distaltip. The analysis also gives the orientation of the distal tip withrespect to the axis of the proximal end of a spring 63 in the contactforce sensor 53, i.e., the amount of bending of the helical spring.

The contact force sensor 53, comprising the spring 63 in the form of adouble helix is disposed in the distal portion 41 and proximal to theablation electrode 45. Proximal portion 65 of the contact force sensor53 is disposed about a longitudinal axis 67. As the spring 63 isflexible, the longitudinal axis 67 is not necessarily aligned with theaxis of symmetry 51. In other words the contact force sensor 53 acts asa joint between the tip 47 and the segment proximal to the contact forcesensor 53. If there is no force on the tip 47, or if the force isparallel to the axis of symmetry 51, then the distal and proximal endsof the spring 63 align, and the axis of symmetry 51 aligns with thelongitudinal axis 67 of the distal portion of the catheter (proximal tothe contact force sensor 53). If there is an asymmetrical force on thetip, then the two axes do not align. In all cases the orientation of thetransducer, the beam emitted by the transducer; may be calculated, andthe alignment or nonalignment of the two axes may be determined.

The contact force sensor 53 is disposed between a paired radiofrequencyreceiver 59, which functions as a location detector and a singlefrequency transmitter 61. In this embodiment the receiver 59 is distalto the transmitter 61. However, they may be disposed in the oppositeorder. The transmitter 61 is a single frequency transmitter that is asimple dipole radiator, basically a single coil.

Reference is now made to FIG. 3 , which is a schematic, sectional viewof the distal end of a catheter in accordance with an embodiment of theinvention. A coupling member 71 forms a joint 73 between distal tip 75and the distal end of insertion tube 77. By way of example, couplingmember 71 is assumed to be formed in two parts, a first part 79 and asecond part 81, the two parts being fixedly joined together. The twoparts of coupling member 71 are generally tubular, and are joined sothat the coupling member also has a tubular form. Although there is nonecessity that coupling member 71 be formed of two parts, the two partimplementation simplifies assembly of a magnetic field generator andmagnetic position sensor into the member. The two part implementation istypically also facilitated by incorporating an attaching stem (notshown) into one of the parts.

Coupling member 71 has a one spring or a plurality of intertwinedhelical springs cut along a portion of the length of first part 79 ofthe member. The plurality of helices may comprise any integral number ofsingle helices greater than one, such as, but not limited to two, threeor four helices. For simplicity, unless otherwise stated, in thefollowing description the plurality is assumed to comprise twointertwined single cut helices, a first cut helix 83 and a second cuthelix 85, and is also referred to herein as a double helix. Those havingordinary skill in the art will be able to adapt the description withoutundue experimentation to encompass a plurality of intertwined heliceswhere the plurality is more than two single helices.

Coupling member 71 (along with the distal end of catheter 69 generally)is typically covered by a flexible plastic sheath 87. When catheter 69is used, for example, in ablating endocardial tissue by deliveringradio-frequency electrical energy through electrode 89, considerableheat is generated in the area of distal tip 75. For this reason, it isdesirable that sheath 87 comprises a heat-resistant plastic material,such as polyurethane, whose shape and elasticity are not substantiallyaffected by exposure to the heat.

As noted above, catheter 69 comprises a transmitter 91 and a positionsensor 93 within a distal portion of first part 79. The distal portionof the first part is located within distal tip 75. The position sensor93 and the transmitter 91 are connected via conductors 95, 97,respectively, to a processing unit at the proximal end of insertion tube77, typically in the console 24 (FIG. 1 ). Position sensor 93 isconfigured to sense the position of the distal tip relative to thedistal end of insertion tube 77. As explained above, the positionchanges in response to deformation of the coupling member, and theprocessing unit may thus use the position reading in order to give anindication of the pressure exerted on and by the distal tip. A fullerdescription of a force sensor using these components is given incommonly assigned U.S. Patent Application Publications No. 2011/0130648and 2009/0093806, which are herein incorporated by reference.

Reference is now made to FIG. 4 , which is a graphical illustration of areceiver 99 that is suitable for use as the receiver 59 (FIG. 2 ), inaccordance with an embodiment of the invention. The receiver 99preferably includes two or more and more preferably three sensor coils101, 103, 105 wound on air cores. The coils have mutually orthogonalaxes. The coil 105 is conveniently aligned with the long axis of thecatheter. The coils 101, 103, 105 are closely spaced along the axis ofthe catheter to reduce the diameter of the locating sensor and thus makethe sensor suitable for incorporation into a catheter.

For most applications, quantitative measurement of the position andorientation of the catheter distal end relative to a reference frame isnecessary. This requires at least two non-overlapping radiators thatgenerate at least two distinguishable AC magnetic fields, the radiators'respective positions and orientations relative to the reference framebeing known; a radiator driver, which preferably continuously suppliesthe radiators with AC signals to generate the AC magnetic fields; and alocation sensor, consisting of at least two non-parallel sensors tomeasure the magnetic field flux resulting from the at least twodistinguishable magnetic fields. The number of radiators times thenumber of sensors is equal to or greater than the number of degrees offreedom of the desired quantitative measurement of the position andorientation of the sensors relative to the reference frame. When it isdesired to determine six position and orientation coordinates of thedistal tip of the catheter, at least two coils are required in thereceiver 99. Preferably three coils are used to improve the accuracy andreliability of the position measurement. In some applications wherefewer dimensions are required, only a single coil oriented orthogonal tothe axis of dipole emission by the transmitter may be necessary in thereceiver 99.

Leads 107 are used to carry signals detected by the sensor coils 101,103, 105 to a signal processor via the proximal end of the catheter, forprocessing to generate the required position information. Preferably,the leads 107 are twisted pairs to reduce pick-up and may be furtherelectrically shielded. Further details of the operation of the receiver99 are disclosed in PCT Patent Document WO96105768 of Ben Haim, which isherein incorporated by reference.

Operation.

Reverting to FIG. 2 , ablation is optimally performed when the annularportion 49 of the ablator is in firm contact with and flush against thetarget tissue. In this situation there is no asymmetrical force on thetip of the catheter, although there is generally a force parallel to theaxis of symmetry 51. The spring 63 is in a resting position and thelongitudinal axis 67 is aligned with the axis of symmetry 51 as shown inFIG. 2 .

Reference is now made to FIG. 5 , which is a graphical illustration ofthe distal portion 41, shown in an operating position in accordance withan embodiment of the invention. The ablation electrode 45 is beingforced into contact with intra-atrial septum 109. However the contactingforce is asymmetric, causing the spring 63 of the contact force sensor53 to flex. The annular portion 49 is not flush against the septum 109,but is incident with the septum 109 at an angle 111. The axis ofsymmetry 51 and the longitudinal axis 67 are not aligned, but meet at anangle 113- In this position analysis of the readings of the receiver 59using the external field generating coils 28 (FIG. 1 ) in accordancewith the teachings of the above-noted PCT Patent Document WO96105768locates end portion 43 of the distal portion 41 of the catheter.

Operating the transmitter 61 at a different frequency than those used bythe field generating coils 28 enables the processor 22 (FIG. 1 ) todetermine the angular deflection of the end portion 43 with respect tothe proximal portion 65, from which the contact force, and the magnitudeof non-alignment with the proximal portion 65 may be computed asexplained in the above-noted U.S. Patent Application Publications No.2011/0130648 and 2009/0093806. Because of the axial symmetry of thefield generated by a coil, in the embodiment of FIG. 5 only themagnitude of the deflection, i.e., the angle 113, can be computed usinga single coil in the transmitter 61. However, by summing the orientationof the receiver that was obtained using the field generating coils 28and the angular deflection, it is a straightforward matter for theprocessor 22 (FIG. 1 ) to derive the 3-dimensional orientation of thetransducer, and hence the direction of beam emitted by the transducer.The transducer direction can be improved by calibrating the beamrelative to the position sensor orientation.

The processor 22 (FIG. 1 ) may be configured to report when the endportion 43 is in alignment with the proximal portion 65, Optionally, theprocessor may then actuate the transducer in order to determine thetissue thickness.

Reference is now made to FIG. 6 , which is a graphical illustration ofend portion 43 shown in an operating position in accordance with anembodiment of the invention. The end portion 43 is essentiallyorthogonal to the septum 109, and the annular portion 49 is flushagainst septum 109, its contact force and orientation having beenadjusted according to information obtained as described above.Ultrasonic transducer 55 has been pulsed activated in A-mode, in whichit transmits and receives pulses of ultrasound energy. Echoes obtainedin this manner from the septum 109 are processed by conventional imageprocessing circuitry, which can be located in the console 24 (FIG. 1 ).As is well-known in the art, the thickness of tissue contacted by theultrasonic transducer 55 is determined simply from the time of flight ofthe ultrasonic pulses. A graphical display 115 of the time-varyingechogram obtained from the ultrasonic transducer 55 and contact forcesensor 53 (seen in FIG. 2 ) is shown at the right of FIG. 6 . Theparameters shown in FIG. 6 can be determined by the processor 22 (FIG. 1) using an ablation index calculated as a product: constant*contactforce*power*time. This index is highly correlated with the tissuethickness. Use of the factors in the index is described in commonlyassigned U.S. Patent Application Publication No. 20140100563 by Govari,which is herein incorporated by reference.

Reference is now made to FIG. 7 , which is a flow chart of a method ofcatheterization, in accordance with an embodiment of the invention. Themethod is explained with reference to the heart, but is applicable toother hollow viscera of the body. The process steps are shown in aparticular linear sequence in FIG. 7 for clarity of presentation.However, it will be evident that many of them can be performed inparallel, asynchronously, or in different orders. Those skilled in theart will also appreciate that a process could alternatively berepresented as a number of interrelated states or events, e.g., in astate diagram. Moreover, not all illustrated process steps may berequired to implement the method.

At initial step 117 a catheter having the features described in FIG. 2is positioned in a cardiac chamber using conventional catheterizationtechniques.

Then, at step 119 contact is established between the tip of the catheterand the target tissue.

Next, at step 121 the tip of the catheter is aligned with the targettissue at a desired contact force. The force sensor measures both themagnitude of the force exerted by the probe, as well as the direction ofthe force with respect to the probe axis. Step 121 comprises step 123 inwhich contact force is adjusted to a desired level and step 125, inwhich the orientation of the tip is adjusted using the readings ofreceiver 59 of signals from the transmitter 61 (FIG. 2 ) such that thedirection of force is orthogonal to the surface of the target tissue.Step 121, 123 may be coordinated by the operator. Once completed, thetip of the catheter and the direction of emissions of the ultrasoundtransducer are orthogonal to the surface of the target tissue. Moreover,the annular surface of the ablation electrode is optimally applied tothe tissue surface.

Next, at step 127 the ultrasound transducer is activated in A-mode.

Next, at step 129 thickness of the target tissue and the depth ofcertain internal structures are derived from the times of flightobtained from the ultrasound transducer and its processing circuitry.

Next, at step 131 ablation parameters, i.e., the intensity and durationof the ablation energy, are determined using the information obtained instep 129. The details of this step are known in the art but are notrepeated here, as they are outside the scope of this disclosure. Thequality of a lesion generated in an ablation procedure depends on theforce and the radio-frequency power being applied to the tissue beingablated, as well as on the thickness of the tissue being ablated and theduration of the ablation.

Then in final step 133 ablation of the target tissue may occur accordingto the requirements of the medical procedure. This can be accomplishedusing the ablation parameters determined in step 131. Optionally,temperature sensors, e.g., temperature sensor 57 (FIG. 2 ), may be usedto monitor progress of the ablation.

It will be appreciated by persons skilled in the art that the presentinvention is not limited to what has been particularly shown anddescribed hereinabove. Rather, the scope of the present inventionincludes both combinations and sub-combinations of the various featuresdescribed hereinabove, as well as variations and modifications thereofthat are not in the prior art, which would occur to persons skilled inthe art upon reading the foregoing description.

The invention claimed is:
 1. A method, comprising the steps of:contacting a flexible probe with target tissue in a cavity wall in abody of a subject, the flexible probe having a proximal portion, adistal end having a longitudinal axis, a distal segment having a tipcentered about an axis of symmetry and an ablation electrode disposed onthe tip, the ablation electrode having annular portion centered aboutthe axis of symmetry, a resilient contact force sensor in the distalsegment, a transmitter disposed within the flexible probe, a receiverdisposed within the flexible probe and configured for receiving signalsfrom the transmitter for sensing a position of the tip relative to thedistal end, and an ultrasound transducer in the distal segmentconfigured to direct ultrasonic energy parallel to the axis of symmetrytoward the cavity wall; adjusting a contact force between the flexibleprobe and the target tissue in response to readings of the resilientcontact force sensor; determining the position of the distal segmentrelative to the target tissue in response to readings from the receiver;determining an angle of deflection between the axis of symmetry of thetip and the longitudinal axis of the distal end in response to theadjusted contact force between the flexible probe and the target tissuebased on the signals received by the receiver from the transmitter;deriving an orientation of the ultrasound transducer and direction ofthe ultrasonic energy to be emitted from the ultrasound transducerrelative to the target tissue based on the determined position of thedistal segment and the angle of deflection; aligning the axis ofsymmetry of the tip and the longitudinal axis of the distal end inresponse to the derived orientation of the ultrasound transducer therebycausing the distal segment to be positioned orthogonally to the targettissue and the annular portion of the ablation electrode to be flushwith the target tissue such that the ultrasound transducer will emitultrasonic energy orthogonally to the target tissue when activated; andcausing an alert to be generated when the axis of symmetry of the tipand the longitudinal axis of the distal end are aligned.
 2. The methodaccording to claim 1, wherein the resilient contact force sensor isdisposed between the transmitter and the receiver.
 3. The methodaccording to claim 1, wherein the transmitter is a single frequencyradiofrequency transmitter and the receiver comprises a single receivingcoil.
 4. The method according to claim 1, wherein the resilient contactforce sensor forms a joint between a proximal portion of the flexibleprobe and the tip of the distal segment.
 5. The method according toclaim 1, wherein orienting the ultrasound transducer is performed whilemaintaining the desired contact force.
 6. The method according to claim1, further comprising activating the ultrasound transducer to emitultrasound signals after orienting the ultrasound transducer.
 7. Themethod according to claim 6, further comprising processing echo signalsreturning from the emitted ultrasound signals to determine a structureof the target tissue.
 8. The method according to claim 7, whereindetermining a structure of the target tissue comprises determining athickness of the wall of the cavity.
 9. The method according to claim 7,further comprising: determining ablation parameters in response to thedetermined structure of the target tissue; and activating the ablationelectrode according to the ablation parameters to ablate the targettissue.